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Improvement of Spastic Stroke Hemiparesis Using rTMS Combined with Motor Training

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Systems Neuroscience and Rehabilitation

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Abstract

Stroke is the second most common cause of death and the leading cause of chronic disability in adults worldwide. Patients with chronic stroke often show increased flexor hypertonia in their affected upper limbs. Although an intervention strategy targeting the extensors of the affected upper limb might thus be expected to have benefits for functional recovery, conventional repetitive motor training has limited clinical ­utility. Recent studies have shown that repetitive transcranial magnetic stimulation (rTMS) could induce motor recovery. Therefore, we developed a new hybrid rehabilitation comprised of rTMS and motor training of the extensors in order to counteract flexor hypertonia. Five hertz rTMS of the upper-limb area of the primary motor cortex (M1), combined with extensor motor training, had a greater effect on motor recovery than either intervention alone in chronic stroke hemi­paresis. It resulted in an improvement of extensor movement and grip power, along with a reduction of flexor hypertonia in their paretic upper limbs. In addition, we found the long-lasting effect for more than 2 weeks, by repeating the hyprid rehabilitation 12 times in patients for 6 weeks. These findings indicate that this method can facilitate use-dependent plasticity and achieve functional recovery of motor impairments. This new hybrid form of rehabilitation could be a powerful rehabilitative approach for patients with hemiparetic stroke.

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Authors and Affiliations

  1. Human Brain Research Center, Kyoto University School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Satoko Koganemaru, Tatsuya Mima & Hidenao Fukuyama

  2. Department of Physical and Rehabilitation Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan

    Satoko Koganemaru & Kazuhisa Domen

Authors
  1. Satoko Koganemaru
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  2. Tatsuya Mima
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  3. Hidenao Fukuyama
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  4. Kazuhisa Domen
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Corresponding authors

Correspondence to Satoko Koganemaru or Tatsuya Mima .

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Editors and Affiliations

  1. Systems Neuroscience Section Department of Rehabilitation for Brain Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities (NRCD), 4-1 Namiki, Tokorozawa, Saitama, 359-8555, Japan

    Kenji Kansaku (Chief) (Chief)

  2. Human Cortical Physiology and Stroke Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke (NINDS) National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD, 20892-1430, USA

    Leonardo G. Cohen (Chief) (Chief)

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Koganemaru, S., Mima, T., Fukuyama, H., Domen, K. (2011). Improvement of Spastic Stroke Hemiparesis Using rTMS Combined with Motor Training. In: Kansaku, K., Cohen, L.G. (eds) Systems Neuroscience and Rehabilitation. Springer, Tokyo. https://doi.org/10.1007/978-4-431-54008-3_4

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  • DOI: https://doi.org/10.1007/978-4-431-54008-3_4

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-53998-8

  • Online ISBN: 978-4-431-54008-3

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